Page:Acute Poliomyelitis.djvu/51

SYMPTOMATOLOGY 39 5. The ataxic.

6. The polyneuritic (resembling neuritis).

7. The meningitic.

8. The abortive.

Zappert gives the following classification:

1. Cases in which spinal paralysis preponderates (poliomyelitis in the restricted sense) with ultimate implication of the respiratory musculature (Landry's paralysis).

2. Cases with marked cerebral symptoms, especially referable to implication of the cranial nerves, more rarely, of the cerebral cortex.

3. Cases without special affection of the central nervous system, but with more or less marked meningeal, gastrointestinal or general febrile symptoms.

P. Krause differentiates:

1. Spinal form (poliomyelitis acuta).

2. Bulbar form.

3. Cerebral form: (a) Meningitic; (b) encephaliti ; (c) ataxic (cerebellar).

4. Abortive form.

5. Recurrent or relapsing form.

Although I recognize that a simplification of my classification would be desirable, I cannot perceive that the grouping either of Zappert or of P. Krause marks any advance. They differ from one another: the ataxic Zappert includes with the bulbar, Krause with the cerebellar; the meningitic Zappert places in the same group as the abortive, Krause as the cerebral. Neither of these groupings seems to me to have much purpose. Indisputably, meningitic cases occur which prove fatal, and a whole series of cases run a course typical of spinal meningitis without affording any clinical evidence of implication of the brain. From my personal experience and from my intimate knowledge of recent literature, I believe that my classification is not only correct but also that its nomenclature gives the physician the best survey of the various clinical aspects of the disease. Zappert has acknowledged the didactic value of my classification. I might even assert that from my classification, one could picture the general features of the symptomatology of the disease.

B. Details of the Initial Symptoms and of the Various Forms.